Provider Demographics
NPI:1265451850
Name:GILLASPIE, CONSTANCE JEANINE (PA)
Entity Type:Individual
Prefix:MISS
First Name:CONSTANCE
Middle Name:JEANINE
Last Name:GILLASPIE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:PO BOX 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:4230 PHILIPS FARM RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-0067
Practice Address - Country:US
Practice Address - Phone:573-882-4800
Practice Address - Fax:573-882-0723
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2004005750363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOQ38576Medicare UPIN
MO000097175Medicare PIN